Podcast Episode 26 Transcript

Interview with Michael A. Freeman MD

Michael A. Freeman MD


Dr. Freeman MD, DMH, who is a psychiatrist, serial entrepreneur, executive coach, entrepreneurship researcher and behavioral health systems architect. He blends expertise in business strategy, operations and organizational development with competencies in psychology, biological psychiatry, health policy, health systems, digital health and public health. A widely published author and acclaimed keynote speaker, Dr. Freeman has been featured and quoted in many media outlets including the New York Times, the Washington Post, Inc., Entrepreneur, and Fortune.

Dr. Freeman’s clinical and consulting practices serve entrepreneurs. His research team is supported by a grant from the Kauffman Foundation. He and his colleagues study how entrepreneur mental health issues affect business outcomes. Dr. Freeman recently served as a Director, and as the Chief Medical Officer of Triggr Health, a venture capitalized mobile digital platform to support people in addiction recovery. Michael A. Freeman, MD, DMH, is the founder of Econa, the wellness and mental health accelerator for entrepreneurs. Econa is building scalable solutions for founders and co-founders who seek to enhance mental health, sustain wellness, improve business and life outcomes, and flourish as people.


Michael A. Freeman MD

Interview with Michael A. Freeman MD (Econa)

Show notes

Michael: Hi, Katerina. Thank you for having me as a guest. 

Katerina: Thank you for coming to the show, to the programme. I’ve just done a short introduction about you but you are pretty much of a celebrity when it comes to mental health for entrepreneurs. So I’m really glad to have you on the programme. 

Michael: Well, it’s a pleasure for me to be here and I appreciate that you’re making this a focus for your work. Because I think the more people can engage in this conversation, the more likely we are to just normalise the idea that entrepreneurs are a little bit different from your average bear. And that’s, that’s what gives them the special sauce that they need to create companies, grow the economy, create jobs. But that special sauce is associated with a couple of vulnerabilities. And I think if people can begin to accept that and see the big picture, we’re going to be able to have a lot healthier and happier entrepreneurs out there. So, thank you for creating a platform to have a conversation about that issue. 

Katerina: Thank you for sharing your thoughts on this. But you’ve been doing this for quite a while. You’ve been doing research on mental health, especially focusing on entrepreneurs. How long have you been researching this topic?

Michael: Research? It depends on what you mean by research but I first started observing the mental health differences among entrepreneurs 20 years ago. At that time, I was the CEO of a company. I was a co-founder and CEO and my company at that time had about 300 corporate members, corporate partners. And a bunch of them were startups in early stage companies. By that time I had finished on my psychiatric training, and I was able to recognise that the founders had, many of them had mental health differences that popped out. I could really, you know, see it with my training and background. So in terms of the research, the hypothesis began to evolve about 20 years ago. And then, actual formal research in studies conducted with academic colleagues, I would say, last seven years probably, we’ve been doing that, that kind of research. And the data, by the way, and you may have seen the data, but it confirms my original impression that yep, in fact, there are a lot of mental health issues among entrepreneurs and it’s what, in part, makes them great and it’s in part, what makes them fragile. 

Katerina: Yeah. ‘Cause you published a paper in 2015, Entrepreneurs Touched With Fire…

Michael: Correct.

Katerina: And in that paper you’ve found, well, you’ve identified some possible correlation between the mental health in entrepreneurs, if I interpret results correctly. And yeah, mental health and entrepreneurship, you found some correlation. But your recent study published in 2019 which was, and has been cited on many websites including Forbes, it’s also kind of confirming this and providing more details on the relationship between entrepreneurship and the mental health conditions in entrepreneurs. My question is, well, first of all, if you can just a little bit explain to listeners who haven’t read that study, what were the main findings of this study? What was the initial, sort of, research questions? What did you try to find and what were the results of the study?

Michael: Sure, I’d be happy to summarise that and also let you know that we’ve had a bunch of other papers published since that time. My colleague, Dr. Sheri Johnson, Professor of Psychology at UC Berkeley, is the principal author on, probably the majority of those studies. So if you want to look up our other research, just go on Google Scholar and search on her name. We’ve got a bunch of co-authors. We have a nice group of scholars and researchers kind of looking at this issue right now. But you asked about the principal findings. And I’m going to include findings that came from another study that we have completed but it hasn’t been published yet. Nonetheless, they all tend to point in the same direction. Okay, finding number one. 100% of entrepreneurs have a personality. Now, what is a personality? Personality is a predisposition to respond to the same circumstance in more or less the same way, most of the time. You are an ambitious entrepreneur starting a podcast, creating a business empire. And you like to take risks. I’m a cautious doctor. I want to make sure I do no harm and that everybody at least survives. And so when we drive up to a stoplight that’s yellow, because you’re the high risk entrepreneur, that’s your personality, you’re going to drive through because you see the opportunity of getting to the other side. I’m a cautious physician, I’m going to stop at the yellow light because I see the risk of going through the intersection when people are coming the other way. 100% of entrepreneurs have a personality. And the personality profile of entrepreneurs is unique. And that’s kind of where the secret sauce comes from. Now, with this unique personality, each of those personality traits associates with mental health conditions. And what we found is that, by mental health condition I mean a diagnosable issue that can have, can create strong emotional states and intrusive symptoms that has the potential to derail your effectiveness as an entrepreneur. So for example, everybody knows what depression is. If you are an entrepreneur and you’re depressed, that has an adverse impact on both your personal life but also your executive functioning and your performance as an entrepreneur. And so it has business consequences and then ultimately, that spills over and has ecosystem consequences. So long story short, there are a bunch of personality traits that are more common among entrepreneurs, very well established finding by now. And there’s a kind of a portfolio of mental health vulnerabilities associated with those personality traits. High on the list would be ADHD, Attention Deficit Hyperactivity Disorder, bipolar spectrum conditions. And also, anxiety and depression, at least as much as population base rates. In other words, if you compare entrepreneurs with managers, for example, anxiety and depression is going to be about the same. And then, which is a big number, and so you can’t really ignore it. And then a predisposition to what I kind of packaged together is impulsive-compulsive and addictive behaviour. And so that would be workaholism and serial entrepreneurship. You know, as behavioural features people can relate to. But also, you know, more likely to live it up when you’re networking at a cocktail party. So, that, I would say is kind of the overall package that by and large, we see most commonly among entrepreneurs. Now, everybody’s gonna want to know, do all entrepreneurs have these mental health conditions? The answer is no. Really, you know, in one study, we found 49% of the entrepreneurs reported a lifetime occurrence of one of these things. In this other study that’s not published yet, the number was lower, was more like 39%. So they’re big numbers, however you slice it, but it’s not the majority. So, what about those other people, the majority of entrepreneurs that don’t really have a diagnosable mental health condition? What’s interesting there is that more than half of them, or about half of them, come from families in which their brother or their sister or their parent or their child has one of these kind of major league mental health issues. And so, they are in effect, they’re the, they’re the kind of more, well, ambassadors of these families that are kind of genetically loaded for mental health differences. 

Katerina: Yeah. But what I liked about this study is that, I was actually looking for a word and you call it entrepreneurial addiction or something like that. That’s me. I failed two businesses and, well, I had two failed businesses. Probably, I didn’t fail them but I had two failed businesses and I’m still at it. And I’m thinking, why on earth do I bother? What’s going on in my brain?

Michael: I know.

Katerina: You just have …like a, kind of a bug sitting in you.

Michael: You have a bug sitting in you?

Katerina: Yeah, it’s like a bug, but I don’t know how to explain it. But in this study. What was the, I know the size was 249 entrepreneurs, but what was the sort of the break? Yeah, what was the sample? Did you use female entrepreneurs and male entrepreneurs? Because it wasn’t very clear for me. Is this, the characteristics you mentioned, are they kind of applicable to female entrepreneurs as well as male entrepreneurs?

Michael: Yes, they are. The study that you’re talking about, with the 250 entrepreneurs, that was a convenient sample. And so our methods could have been better. But that’s why, the study that isn’t published yet, we used a national probability sample. We were very fortunate to be able to collaborate with one of our co-investigators, Sangeeta Badal, Dr. Sangeeta Badal. She’s the head of the entrepreneurship practice at the Gallup Organisation which is a big national polling and Human Resource Development firm in the United States. So, the Gallup database was available to us for that study. It was a randomised national probability sample in which we compared a thousand entrepreneurs to a matched sample of a thousand managers. Way, way better sample. Way better statistical methods. And to answer like the prevalence questions, I have to actually pull up the data and take a look at it for you but the gender issue is that, would want to have that data right in front of me before I answer. But in general, women entrepreneurs are as vulnerable and pretty much everything as male entrepreneurs are. Entrepreneurs tend to be about two-thirds men, one-third women. There’s a big controversial literature about why that is. And there are some mental health conditions that are more likely to occur among women. For example, anxiety.

Katerina: Anxiety, yeah, that’s right. 

Michael: There’s some mental health conditions that are more likely to occur among men. I think sort of impulsive, more impulsive-related conditions. There are some mental health conditions that are more likely to be diagnosed among men, but equally prevalent between men and women. ADHD would be an example of that. 

Katerina: Yeah. 

Michael: But I would say that regardless of whatever your gender might be, we’re doing another study right now by the way, if you’re an entrepreneur listening to this, you can go to our website, Econa, E-C-O-N-A dot net, and you can take a survey. We’re doing a mental health profile about the impact of COVID-19 on the well-being of entrepreneurs. And in this one, we’re also asking about non-binary gender identity. So we’ll hopefully have some data about that as well. But by and large, I would say, regardless of whatever your gender maybe if you’re an entrepreneur, being aware of your well being and mental health and making it a priority is a good idea. 

Katerina: Yeah. And also, I don’t know if you’ve come across any studies that actually looking at the causal relationship between mental health and entrepreneurship, because it would be good to know whether intrapreneurial activities are likely to lead to more mental health problems in both male and female. Or whether people with, you know, teenagers and and children who have mental problems in, you know, in adolescence or childhood, potentially are more likely to become entrepreneurs later on in life. Because for example, if I say entrepreneurial activity leads to greater risk of mental health problems, then it would be a good idea for entrepreneurs before they even start out that business, right? And think about finding capital and spending all this money and effort on soliciting their business. Actually first think about how to become more resilient, right?

Whereas, you know, if say, teenagers and kids have mental health problems, and they’re more likely to become entrepreneurs later in life, then perhaps the traditional educational pathways are not right for them. And there should be different alternative educational paths for those kids to encourage them to become entrepreneurs. What’s your view on that?

Michael: Well, you have a lot of big ideas. Let me pull them apart one by one. The first question you asked was about cause and effect. And then the second question you asked was, can you identify adolescents that are more likely to become entrepreneurs and should we educate them differently. Let’s start with that one. The answer is yes. There is a body of research about the relationship between certain teenage behaviour patterns and mental health conditions and the likelihood of becoming an entrepreneur. And one famous study, the first study actually that picked this up, was a longitudinal study of children in the late 1990s. And in this sample, they were able to identify a subset of children that had ADHD. School kids, you know, middle school, 13,14-year old kids. And overtime, as they followed the sample, the children who had ADHD issues in early, mid, late adolescence were significantly more likely to be self employed and entrepreneurs and small business owners by the time they became adults. There are other indicators, there’s a literature on this. There are other indicators in the adolescence of people who were more likely to become entrepreneurs. Should we teach them differently? You know, that’s a researchable question.

My opinion is yes. The kids who become entrepreneurs tend to be really smart but have lower grades. And, you know, they can be diagnosed with learning disabilities but in my opinion, it’s actually, the schools have a teaching disability. Schools in Europe and in the United States after World War II, the educational system bought into the concept of human capital and human capital formation as a pathway to economic development. The idea was the more professionals, scientists, engineers, architects, whatever that you train, the more likely the economy is to grow. Entrepreneurs do not fit into the model of human capital. Entrepreneurs live in a different world which is referred to as creative capital. And the educational methods that apply for human capital formation don’t necessarily apply for creative capital formation. And we could talk about that in another podcast, but the overarching answer is yep, they probably would fare better if they were educated differently. You want to talk about that or are you interested in cause and effect?

Katerina: Why I’m asking about cause and effect is because we’ve had guests on this podcast who would say that they never experienced any mental health problems or conditions such as anxiety, toxic stress or burnout before they started their business, right? So they started the business and then they started experiencing all these conditions. And then we also had some guests who had a previous history of depression, eating disorders and stuff like that and they kind of having a go at, you know, founding a business and running a business. So it’s interesting to know whether there is a relationship between mental health and entrepreneurship. Are we likely to become more, mental is not the word probably, prone to mental health problems when we start the business and then if that’s the case, how do we encourage more entrepreneurs if they know for sure, well, actually, I’m going to end up having problems, mental problems if I do this. 

Michael: Yes. One thing to keep in mind is that those entrepreneurs might have emotional issues if they don’t do it too.

Katerina: Oh, yes.

Michael: For example, you mentioned that you have a bug in you and you’re on your third go round right now. 

Katerina: Yeah.

Michael: I’m pretty confident that you would be unhappy if you weren’t doing something entrepreneurial too. So you’ve got to keep that in perspective. The research on entrepreneurs is pretty clear that the  true entrepreneurs would rather be self-employed than to hold a job, and that they will put a lot of energy into finding ways of participating in the economy in a manner that allows them to have a lot of independence and autonomy. Now, you mentioned two different experiences for entrepreneurs. Those who had mental health issues before beginning companies and those who developed mental health symptoms as they got into business building.

And the way that I think about it is that as an entrepreneur, you can think about what do you bring to the party and what does the party bring to you? What you bring to the party is either, from a mental health perspective, either you already have had mental health issues earlier in life, things like ADHD or anxiety or depression, whatever, substance use. And so you’re entering entrepreneurship with a known vulnerability to one or another kind of mental health condition. In fact, that’s what drives you to entrepreneurship. I mean, the traits associated with bipolar spectrum, the traits associated with ADHD, for example, and those personality traits, entrepreneurship in your pedigree, a pretty good fit. That’s going to be your happy place. And then what does the party bring to you? The party brings stress, conflict, lawsuits, competition, co-founder issues, difficulty with finding product-market fit, friends and family investors who are now mad at you because they didn’t get their money back.

All kinds of things go wrong as an entrepreneur and they’re very, very impactful. And by and large, entrepreneurs are more resilient than, on average, are more resilient than managers and employees. But everybody has their tipping points. And those entrepreneurs that you have interviewed, never had any mental health issues before getting into it, all of a sudden can find themselves having insomnia, and anxiety, and burnout and panic attacks and feelings of futility and hopelessness, you know? And then they work harder and harder and harder and then their marriages begin to get, you know, suffer for it. So, it really, it’s both ends. What do you bring to the party, what does the party bring to you? It’s when you’re, getting in, starting a business is kind of like rafting on whitewater, if anybody who’s ever been river rafting. You’re going through turbulent rapids and you know ahead of time, you know the most likely outcome is that your business is going to wipe out. 

Katerina: Don’t I know this. I was, yeah, I had heart palpitations and I thought there was something wrong with my heart when my first business failed. And I couldn’t sleep for a year, I’ll be honest with you. I was sleeping tablets for a year and then I kind of said to myself, that’s it, no more. I went like cold turkey, stopped taking any tablets and for two weeks, I was really trying to get my sort of sleep back and kind of tried to do a lot of self talk. But you know, you just keep going to the time and thinking, well, what could I have done differently to make it a success? And you just keep beating yourself up. But then no no one is becoming Mark Zukenberg overnight right? You know, straight away. I mean, like in Silicon Valley, nine out of ten startups, they fail, right? And successful entrepreneurs, often entrepreneurs who fail, beat themselves up and start again, try a different strategy, a different approach, and then maybe fail again and then start again and they may or may not succeed. But I understand, totally. You know, how anxious you can become running your own business. Especially at this early stage when you are looking for clients, you’re looking for sales and you may have a couple of sales and then you think, you know, what am I doing wrong?

Why can’t I break even or, you know, putting all this hours and yeah, so I understand this totally that’s why I have this interest in mental health. Being a teacher myself, I’m teaching entrepreneurship, creativity and innovation at the university but also kind of very intrapreneurial. And I’m trying to teach students how to be more resilient actually because I understand this is very, very important for their future. But saying that, will people even have a choice in the future because I’ve read your comments about, you know, your view about technological unemployment, I think you called it unemployment tsunami, and I do agree with you. In the last couple of years I’ve been working on a book, all to do with displacement of jobs, and the conclusion I arrived at is that entrepreneurship might be the only way for people to be relevant in a society. Because like you said, you know, large corporations, they do everything they can to reduce costs, to automate operations and systems and so on. And entrepreneurship might be the only way forward for a lot of people in terms of unemployment. 

Michael: That is a reasonable hypothesis. I wouldn’t, I don’t know about the sort of totalistic, all or nothing component, but certainly if you read the literature on the intersection between globalisation and robotics and artificial intelligence and automation, it certainly seems that greater and greater and greater segments of economic activity can be automated. And that more and more and more jobs can be displaced and it’s already happening on a pretty large scale. And the companies that are growing now are companies that, in many instances, have the effect of reducing the need for labour. So your observation is that there are certain kinds of jobs that can’t be automated, that won’t, or most likely won’t be automated, and that entrepreneurship is on the list of that. I’m not sure it’ll be the only surviving category but…

Katerina: Psychitrists are on the list as well.

Michael: Believe it or not, there are actually a number of AI programmes out there. They provide mental health services and they’re getting pretty good reviews. And so if you have depression, for example, there are sort of computerised, cognitive behavioural therapy protocols that you can go through. And your outcomes may not be appreciably worse than if you see a licensed mental health clinician. So even in medicine, all branches of medicine, automation is being applied.

Katerina: But I mean, even say take education. It all started in academia. And, yeah. I mean there are systems already teaching students. 

Michael: The challenge though for your hypothesis is that not everybody can be an entrepreneur. Most people can’t be entrepreneurs. 

Katerina: Yeah. 

Michael: Maybe that we should do a better job of identifying and resourcing people that have the potential…

Katerina: Yeah.

Michael: …to be entrepreneurs as a way of stimulating economic growth because the other fact that is repeatedly identified, is that most new jobs are created by companies that are less than five years old. The vast majority of new jobs. And as automation eliminates traditional workforce kinds of jobs, we have some social policy issues to figure out. And it seems that job creation is going to end up being a priority, a social policy priority, which means entrepreneurs will be very relevant in that regard. 

Katerina: No, I definitely agree with you on this. But I guess it’s just a matter of time because if you look at the spendings of large corporations on automation and the figures published by companies, such as …, actually adopting artificial intelligence and the impact on productivity. I mean, it’s some scary statistics but, you know, people who will be replaced will be replaced. But of course, like you said, there’ll be people who won’t be replaced. But then again, even to work for a big corporation, you have to have resilience and again, I can’t remember the study of …, but was all to do with, you know, functioning in VUCA world, right? Because the world is becoming increasingly volatile and uncertain and complex, and people who will be employed, they call them superstars, right?

They will have to have not just skills such as creativity and be emotionally, you know, what is the word? Emotional intelligence, right? But they’ll also have to have resilience, mental resilience as well. So, yeah, we’re potentially going to see a major sort of display, you know, displacement of a lot of people and people will have to be re-skilled. But then again, will people have, you know, enough mental capacity to even do that? That’s another question. But going back to your research. And, obviously, you know, anxiety is, I’d say quite a healthy response, right? And in small doses, anxiety is nothing to be afraid of. But how can entrepreneurs spot when anxiety can become something more, more of a concern? Like a mental problem? How can they support the change?

Michael: I’m trying to formulate the best way to answer that question. Anxiety is an emotion related to fear. And all of these emotional, mental health issues are associated with four dimensions —  social, emotional, cognitive, and behavioural. So, the social dimension of anxiety is avoidance. People who are anxious can be shy. And they can perceive interacting with other people as being potentially more risky and dangerous than it actually is. The emotional component is fear. And as you talked about with your heart beating and with your muscle tension and grinding your teeth and not sleeping. The cognitive dimension is worry. You spend a lot of time worrying about what might go wrong, having catastrophic thinking, what if this happens, what if that happens, the sky is falling. And the behavioural is a wide range of manifestations, but it can be like getting frozen like the deer in the headlights, if you know what I’m talking about. Typically, people who have anxiety go through, fight, flight and freeze. And if you’re in flight mode where you avoid or if you’re in freeze mode where you just stall out, all of those things can one way or another interfere with your ability to lead your business, operate your business. So, I tell entrepreneurs to look at these emotions as a signal. Your brain is signalling something to you. You know, your brain, in the case of anxiety, your brain is signalling to you that there is some risk or danger out there that you need to be aware of and proactively get your hands around. But if you’re one of those people who’s more vulnerable to anxiety than normal, you can overreact. And if you overreact, you’re going to have to make, you know, emotional decision making, emotional communication. Your anxiety is an infectious emotion. If you’re worried and you communicate that to your team, your team is going to get worried and then the whole company is going to be anxious and people are going to start figuring out if they should be looking for another job or, you know, fighting tactical fires instead of making important strategic decisions. And so, it’s important to have some tools in your toolbox to manage and regulate your own emotions so that you can still function effectively. Yes, it’s good to know that you’re having a hard time making sales, so you’re having, there’s something wrong with the relationship between your product and the market out there. Now that you know that, don’t have panic attacks. You need to like, regulate the emotions so that you can think about it in a more effective manner.

And then, effectively, do your hypothesis testing. Is it the product? Is it the price? Is it the distribution channel? Is it, you know, and then there’s a way to fine tune the product and the market, you know, getting the product to fit the market and vice versa. You go down that path. But if you are too anxious and you’re not sleeping, and you’re worried all the time and you’re communicating alarm to your investors and your employees and whatever, then you could go into a tailspin and that could lead, be one of the factors that leads to the business getting derailed. 

Katerina: Yeah. So, I mean it’s hard to have something else to talk about because sometimes you just kind of, you go into entrepreneurship, like almost wearing a, you know, glass, what’s it called?

Michael: Rose-colored glasses.

Katerina: Rose-colored glasses. And there is also like a mantra, you know, you have to fake it till you make it and a lot of people just kind of, they pretend that they’re crushing it, right? It’s the phrase? Gary Vaynerchuk’s phrase, crushing it. But in fact, I mean, they might be experiencing almost mental issues and no one seems to be talking about these issues. Why do you think many small business owners ignore mental health, you know, problems? 

Michael: Why do entrepreneurs and small business owners ignore mental health problems? I think you suggested a couple of issues. One is managing impressions, and another is lack of awareness. And a third is not having a safe space to open up about it. I’m, right now, I’m trying to solve the third problem. And the second problem with Econa, which you mentioned before, we’re trying to create some resources that can help entrepreneurs manage this set of issues more effectively. But in terms of the three blockers, entrepreneurs experience a lot of pressure to project an image of success. And one of the social skills that’s important for entrepreneurship is impression management.

Entrepreneurs need to have a lot of different kinds of relationships with a lot of different people — customers, suppliers, team members, co-founders, employees, investors, many, many different constituencies need to come together to form a coalition in order to empower a business to succeed. And so, there’s a lot of emotional labour involved in entrepreneurship. But as an entrepreneur, you need to be able to emotionally engage with every stakeholder in that consortium. And to hold that consortium together, entrepreneurs are called upon to create goodwill and motivation among all of the stakeholders to collaborate in ways that allow the business to succeed. So, the founders often believe, and possibly with reason, that if they were to communicate and express vulnerability within that network that they may lose traction that they need on behalf of the business.

So there’s the pressure that, you know, to convey a level of confidence that may not actually be warranted. Now, when entrepreneurs commit suicide, and they do, in our most recent study, we found that 1.4% of these 1000 entrepreneurs in the national probability sample reported a history of psychiatric hospitalisation. And we found that 3% of the entrepreneurs reported history of suicidal thinking, suicidal ideation. So, when these kinds of things happen, you hear the argument, why don’t we just educate investors, suppliers, customers, team members to understand that entrepreneurs are people? And like everybody else, they have a breaking point. And they have vulnerabilities. And they’re not these, you know, idealised celebrities that always win and never lose.

And I think that your podcasts and all kinds of public awareness type of exposure can go a long way to helping investors and team members and co-founders and suppliers appreciate just how much risk these entrepreneurs are taking on and what kind of pressure they’re under. So, the first blocker, like I said, is the need to manage impressions. The second blocker is stigma. And that in Europe and in the United States and in Canada, and even more so in other parts of the world, there’s a lot of shame still associated with things like bipolar spectrum or substance use or depression or panic attacks or whatever, you know, the issue may be. 

Katerina: I mean, you mentioned suicide and I am aware of, you know, several entrepreneurs who committed suicide. Take for example, the fashion designer Kate Spade. I mean, but, of course, those entrepreneurs, they also had a history of depression. Because depression often leads to suicidal thoughts and heightened risk of suicide. But my next sort of question is that, a lot of the time, you know, doctors, psychiatrists, they prescribe antidepressants and medication and which, you know, if you look at the side effects of those meds, you’ll see that they potentially may in the long run may lead to suicidal thoughts and may be causing those enterpreneurs to commit suicide. What’s your thoughts on taking medication for depression?

Michael: Let me correct what you just said. What I heard you say is that some antidepressants actually cause suicidal ideation as a side effect. And that is not the case with one exception. There are reports of some people who take SSRIs, particularly young adults and children, who do develop suicidal ideation. And what the physician needs to know is that there are subtypes of depression. So you think that depression is just one thing, you know? And you think a garden variety depression. But for me as a psychiatrist… I’m aware that there are several subtypes of depression. And one of those subtypes is the kind of depression that’s associated with bipolar spectrum condition, you know, manic depressive illness.

And another one of those subtypes is called recurrent unipolar depression. If you give the wrong antidepressant to someone whose depression is related to the bipolar spectrum, it can cause bad side effects. And that’s why the psychiatrist has to be very mindful and very careful to properly assess what kind of depression they’re dealing with before they prescribe antidepressants. When the antidepressants are properly prescribed, they’re much more beneficial than problematic in terms of side effects.

Katerina: Yeah. Two of my family members, I mean, they took antidepressants and they did share some views on, you know, and they said they felt sometimes, you know, sometimes they had suicidal thoughts. So, but, again, what is the option for people who don’t want to take any medication? How can they nourish their mental health?

Michael: There are many, many options. Medication is necessary for some of the more extreme, some of the more severe mental health conditions. But in the mild and moderate range of mental health issues, there are a lot of lifestyle and behavioural and prevention-oriented solutions that people can call upon in order to maintain their equilibrium. You, for example, in your comments earlier talked about sleep. A simple prevention-related issue that you can focus on is sleep. Sleep is more, and then the second one is exercise. Sleep and exercise together are more effective or equally effective as compared to a wide range of medications for anxiety and depression. 

Katerina: Yeah, but going back to that time, I mean it was really crazy because I had fear that I might not have sleep, without actually trying to fall asleep. So I would, I would take it, because I had fear that I may not sleep.

Michael: Then you became psychologically dependent. 

Katerina: Yes, that’s right. And then I started reading some literature, and I’ve come across this guy saying well, actually, if you don’t sleep, you’re not gonna die or anything like that. And the number of nights where I was just like, watching the clock, was like four o’clock, five o’clock. Oh, I have to get up. It’s okay, you know, you have a couple of mugs of coffee and you write and then it’s kind of went back to normal, you say. But just to be honest with you, I’m one of those persons who don’t want to take any drugs and I always try to find an alternative solution. And I also came across a research by Joanna Moncrieff. She’s the leading psychiatrist in the British psychiatry. And she published several studies where she was kind of, well, she said that the chemical imbalance theory, that many psychiatrists sort of refer to when they prescribe drugs, has been debunked by several psychiatrists. And she published papers where she said that if we prescribe drugs, if you start prescribing drugs to kids, and again, I have a four year old, and he hasn’t had any drugs at all. I’m just not sure with him.

And if you start prescribing drugs from a very early age and if you look at some statistics, you know, small kids today are being prescribed a lot of drugs, then those kids, they grow up thinking that something is wrong with their brain and they won’t take responsibility for their actions. To our conversation about intrapreneurship, if we want in the future for people to be healthy entrepreneurs or, you know, when they already start taking drugs from a very small age, when they grew up, what happens to those people, if they believe that it’s not them taking this? They’re not responsible for their behaviour. It’s something, you know, chemicals in their brain are responsible for. See? So that’s my sort of point of view on drugs. But I understand if people are clinically depressed, maybe the only option for them is actually drugs. 

Michael: These are big questions and entrepreneurs tend to be focused on the next six months. So, I think, for the entrepreneurs who are listening to your podcast, what I would say is, do whatever you can to be well. Have good sleep hygiene, exercise daily, don’t go over the deep end as a workaholic, take some breaks and keep yourself refreshed and restored. Maintain supportive, social relationships with friends, family, loved ones. Don’t make the mistake of confusing your business with your entire identity. It’s just an enterprise, it’s not you. You’re bigger than that. So keep it all in perspective.

And then, if you are, for one reason or another, experiencing significant emotional problems or symptoms that are interfering with your functioning, ask for help. Ask a licensed, trained mental health professional for help, just the same way you ask a lawyer for help about figuring out your operating agreements, and you ask consultants for help around strategy and tactics, you ask engineers for help around automating work processes, and you ask accountants for help in managing, you know, cash flow and reporting. Mental health people are just another kind of consultant at your disposal to provide resources you need to be a more effective entrepreneur. And, you know, like what I said at the beginning, is that your greatest strength is your greatest weakness and that the motivation, creativity, energy, drive that you have that kind of propels you into being an effective entrepreneur can, under the right circumstances, be associated with some of the bigger, you know, bigger and better mental health symptoms. If you get to that point, first do everything proactively to prevent it. If it does happen, don’t mess around. Just deal with it head on. And there are solutions out there that work for you. Yeah, and you know, I don’t personally, I think it’s not a great use of time to debate the, you know, the enterprise, sort of the political economy of the enterprise of mental health. 

Katerina: Yeah.

Michael: Because that’s not really relevant to entrepreneurs. What’s relevant to entrepreneurs is can they be well? Can they be happy? Can they be healthy? Can they have good business outcomes? And can they have good life outcomes? So I just try to focus on those results, delivering those results. 

Katerina: So, what can entrepreneurs do during the pandemic? Because obviously, what’s happening right now, it’s unprecedented, right? And a lot of entrepreneurs I interviewed, they tried to pivot. They tried to find new business models that will work in these difficult times. How can they safeguard their mental health during this global pandemic? 

Michael: It’s very difficult and I give everybody a lot of credit who’s out there right now coping with this. There are lots and lots and lots of businesses that have closed and are just not going to come back. And many of the other businesses are either winners or losers. Some businesses are exploding right now because of the pandemic. A good example is collaboration software. You’re in the podcast business, that’s a great place to be. Podcasts are way up because everything else is way down. There’s more demand for content now than there ever was. If you’re in Netflix, you’re cashing in. But on the other hand…

Katerina: I think… we’re discussing at the moment, not me. I haven’t monetized it yet. I think… is making money.

Michael: Somebody’s figuring it out. Netflix is figuring it out. I Heart Radio is figuring it out there. There are podcast companies out there that are just going gangbusters. But in a lot of businesses, you have to pivot pretty hard in order to just maintain your current business. For example, as you said, I am a psychiatrist. I have not seen a patient in my office since March. I’ve had to pivot 100% of my clinical care that I provide on some kind of platform. So that’s a big pivot. I’ve had to change my operations but as far as my business model, it’s about the same as it always was. But, you know, involved, learning new technologies, developing new relationships, all kinds of stress involved in making an abrupt change in your business model. And then other companies are having to like downsize, right size, re-focus around some products, you know, in your product mix can survive and other other products can’t. Lots of layoffs happening. It’s a very, very hard time for entrepreneurs. 

Katerina: But Michael, you’re also a serial entrepreneur and you’re a psychiatrist. Have you ever suffered from anxiety or depression yourself and how do you manage your mental health? 

Michael: Yeah. 

Katerina: Because you’re not immune to this. I’m sure you’re not immune to this.

Michael: I’m definitely not immune. No, you’re absolutely right. I feel the same emotions as everybody else. In fact, I’m starting a company right now. And so I’m back on the roller coaster and we’re having a great day and we’re having a horrible day and we’re about to, in 90 minutes, we’re going to be providing this great programme that I’m so excited about. But on the other hand, I wish we had like another 20 people in the room. And so you know, it’s very emotional for me just like everybody else. I like that, actually. In Econa, we’re a team of people. Everybody in our team is an entrepreneur, and so we’re entrepreneurs taking care of entrepreneurs. And so we get to have self awareness as we go through the process.

So I go through the normal ups and downs and then under. Not yet with this business but in prior businesses in when there were like, big inflection points. I’ve had big emotional reactions myself. So, yes, it’s true. How do I manage it? Well, fortunately, I have an advantage that a lot of people in entrepreneurship don’t have, which is age. I’m older than the average entrepreneur and that means I’ve got more perspective and life experience. That actually helps a lot. Because I think for a lot of people as you get older, you don’t take yourself so seriously and you don’t take these situations so seriously. So for younger entrepreneurs, particularly those in their late 20s and in their 30s, I would say, a mental health strategy that I use that you could use is keep it in perspective. It’s just an enterprise, it’s not you. And also keep some perspective around most of the reasons that companies fail have very little or nothing to do with you as an entrepreneur. All those companies that just got wiped out by the pandemic and nothing to do with them as an entrepreneur.

So, you know, the raft in the racing river? And you can navigate your raft pretty well but you can’t control how much water is flowing through the river at any given moment. That’s beyond your control and it changes all the time. And then in terms of my own mental health, I do everything I already told you. Everything on that list, I do. I worked out for an hour before the podcast this morning. I do that every morning first thing. I got to bed on time last night. It’s so that I could get more than eight hours of sleep before exercising, before coming on the podcast. I maintain relationships with my group of friends. Most of my like, inner circle of friends, they’re vaguely aware I’m an entrepreneur but it’s not really part of the relationship. And so I’ve got a whole, like social circle that has nothing to do with entrepreneurship. And that my identity as a person is not tied up in whether the business is like doing great or not doing so great. There are people I can talk to about personal issues so I can be vulnerable and I can open up with my wife, for example, and my siblings, and also some close personal friends who are confidants. I follow a healthy diet. Your listeners should know that there are actually antidepressant benefits associated with the Mediterranean diet, as well as all the other health benefits so I follow a Mediterranean diet. Yeah. So, basically hardcore wellness is what I do. 

Katerina: I guess prevention is better than cure. 

Michael: Prevention is better than cure. That’s my mantra. Even for everybody, let’s say you’re one of those people who had a prior history of anxiety or depression. Prevention is better than cure. There’s a lot of things that you can do that reduce the likelihood you’re going to continue having anxiety and depression while you’re an entrepreneur. That’s kind of how I manage it, you know myself. 

Katerina: Yeah. So, what’s your vision for Econa?

Michael: Vision for Econa is to, number one, normalise mental health differences among entrepreneurs. I would like to reduce the shame and stigma associated with mental health by making it clear that the people we rely on, as an economy for jobs, are the same people that have anxiety, depression, come from families where there’s mental health issues, have been in psychiatric hospitals, do have suicidal ideation. So, de-stigmatise by having the conversation that you and I are having right now. Secondly, create resources for entrepreneurs themselves to be well. Like you just said, I think prevention is better than cure. And so we’re trying to create a lot of resources that are focused on prevention and that includes primary prevention, like all the wellness strategies and skills that you can use. But then also secondary prevention. If you know that you’re someone who’s prone to anxiety, kind of walking in the door, what are the specific things that you can learn, skills in self-care skills that you can learn to improve your outcomes as someone who has always been anxious. And the programme that we’re going to be producing in 90 minutes is all about self care skills for people with ADHD.

A lot of entrepreneurs have ADHD, at least issues with organisation, focus task execution and follow through, listening to people, time management. And there are a lot of self-care skills and strategies that you can use as an entrepreneur with ADHD to, kind of, reduce the negative impacts while you still take advantage of the creativity and the energy and the motivation and the extraversion and all of those positive things that go along with ADHD. So self-care skills training. We are heading into creating support groups for people that have more serious issues, support groups around, you know, addiction issues. Support groups around, depression, anxiety, all the above. It turns out, if you have one on the outside, you might have two mental health conditions at the same time. And we have in mind, you know, some intensive training programmes, possibly use of apps. So, and then community. We’d like to create a forum, a community in which there’s a forum. You can go to, open up and be vulnerable so that you don’t have to keep it to yourself all the time. So community support as well. That’s, that’s kind of how we’re thinking about it. Those are the products on our product roadmap, if you will. 

Katerina: Yeah, it sounds great. And I will put a link in the podcast notes to the website so people…

Michael: Okay.

Katerina: …can check it out. Because I’ve looked at the website and congratulations. You just launched it. It’s looking great. But yeah, definitely. It is a platform for entrepreneurs to check out, that’s for sure, who wants to take, I don’t know, some proactive approach to managing their own mental health. But just to wrap up, what would be your sort of final word for entrepreneurs out there who want to start the business or maybe who already started their business. Starting entrepreneurs because I think this is the most difficult time. The first couple of years is the most difficult, you know, time mentally for people.

Michael: For early stage entrepreneurs, I would, if I could give two suggestions, one would be make wellness a priority, checklist I just went through. And the second would be to create your own personal advisory board. And on your advisory board are a couple of people whose job it is to keep you well. And then, on your advisory board are a couple of people who are your executive coaches and mentors for the business. And you have to remember that if you’re not doing your personal best, as far as you’re functioning as a human, you’re not going to be able to effectively lead your organization. So you need both. And on your wellness advisory board, it would be a loved one, a best friend, possibly a therapist of some kind, if you already know that you’re vulnerable around mental health.

And I would talk to those people as frequently as you talk to the business coaches and the business advisors as well, just so you have some support. Along those lines, I really think that peer support groups are a great idea. And if you and five or six other business founders, to meet once a month for four hours or twice a month for two hours, and just check in with each other and support each other and then support each other around getting mental health help if it’s needed. That can be a very stabilising aspect of launching a business as well. So those would be like, where I would start, if you’re an early stage entrepreneur. 

Katerina: No, thank you so much, Michael, for coming to the programme and sharing your views. 

Michael: I do have one more recommendation. 

Katerina: Yeah?

Michael: I do have one more recommendation. The other recommendation would be to listen to Katerina’s podcast and get a lot of great ideas out of her podcasts, so keep listening. 

Katerina: Thank you so much. Thank you and all the best with Econa and I’m sure I’ll be checking it out and hopefully I’ll be part of it as well.

Michael: Yeah, that would be great. That would be great. We do have academic researchers involved that are in our advisory board and we hope, eventually, to have enough data to be able to, you know, do some good research through Econa. It’s on the horizon. It’s not today’s problem but yeah, we love being involved with thoughtful people and research-oriented, scientifically minded people who want to help create this emotional safety net for entrepreneurs. So thanks for the work you do too. 

Katerina: Thank you. Thank you so much for being on the podcast and all the best luck with Econa. 

Michael: Thanks so much.

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